Do doctors have the “democratic” right to charge whatever the market will bear for “uninsured” medical services? Or do the principles of universality and accessibility under the Canada Health Act still apply to the practice of medicine in Alberta?
Apparently some physicians feel they’re underpaid (join the club) and want to get on the “uninsured services” gravy train to supplement their income. The government assists them in this endeavor by arbitrarily delisting various “insured services”. This shrinks the basket of “insured services” and dumps the now “uninsured services” into the laps of enterprising medical professionals who charge market prices for services that once were free—well not entirely free, you paid for them with your tax dollars.
Recently, the College of Physicians and Surgeons (College) asked for feedback on amendments to its Standards of Practice. The purpose of the amendments was to ensure that access to medical care was based on medical need, not the ability to pay. Um…isn’t that the law?
Consultation 0005 quickly blew up into a debate about shutting down private MRI and CT services, the need for a two tier healthcare system and a how-dare-you attack on the College on all fronts.
Standard 18 “Charging for Uninsured Services”
“Insured services” are services the government pays for with your tax dollars. “Uninsured services” are everything else–from writing an absence note so your child can return to school after a bout of measles to “boutique” services like on-site physiotherapists, dieticians, kinesiologists, personal trainers and life coaches.
Nothing in Standard 18 prevents a doctor from charging for uninsured services.
What it does do is require a greater degree of transparency with respect to fees for “uninsured services”. Doctors would have to tell their patients the cost of an uninsured service in advance. They’d have to give their patients a choice between paying an annual fee for uninsured services upfront or paying as they go. In both cases doctors would be required to provide a schedule of fees for each uninsured service. Sounds reasonable, rather like asking your mechanic to check with you before he makes off-warranty repairs to your car.
Doctors would no longer be allowed to charge a fee for “being available” or for providing preferential access (oh good, because that’s illegal). Moreover, doctors could not refuse to accept a patient who wants basic “insured services” but doesn’t want to buy any of the “uninsured” bells and whistles (in the business world that would be anti-competitive tying and bundling—it’s illegal).
Promoting transparency or putting the brakes on two-tier healthcare?
Surely no self-respecting doctor would have an issue with greater clarity and transparency, so what’s the issue?
The Standard says the fee for uninsured services must “reasonably reflect the physician’s professional costs, administration costs and the patient’s ability to pay”.
A physician’s “professional costs” are not the same as a market-based fee so the size of the uninsured pie just got a whole lot smaller. Also, the reference to “the patient’s ability to pay” implies that the fee can be based on a sliding scale—a higher fee for a Daddy Warbucks and a lower fee for Little Orphan Annie.
That makes sense given the financial barriers to accessing private MRIs/CTs.
The response from the medical profession and a smattering of civilians* was brutal. Comments condemning the amendments outnumbered comments in favour by a margin of four to one; 45% of the comments were made anonymously! Is there a pro-privatization secret society out there?
The barrage of criticism started with the mistaken premise that the College was surreptitiously trying to ban access to private MRIs/CTs and boutique clinics, when in fact it was trying to introduce greater transparency and an “ability to pay” limit on uninsured fees.
Commentators castigated the College for attempting to protect a failing public health system, meddling with the physician’s right to decide his own “financial destiny” (this guy should be in advertising), interfering with a patient’s right to choose his treatment, unfairly preventing the rich from accessing private medical services and…wait for it….going over to the undemocratic, socialistic and/or communistic dark side.
The underlying issue
The Anti-Commentators framed the issue like this: A physician’s ability to deliver reasonable access to medical service is hamstrung by our inept government’s budgetary constraints, consequently public healthcare is failing and it’s time to embrace a two-tiered health system. In the words of Anonymous, “Restricting the natural evolution of privatised medicine in this country will be socialistic at best”.
Fair enough–a failing public health system is a legitimate concern, however it is not within the College’s power to redress.
All the College can do, says Dr Matthew Rose, is ensure that Albertans have equitable access to necessary care and that inappropriate billing for “uninsured” services does not become a barrier to appropriate care or a means to privileged care. Hear, hear!
Allowing physicians to offer uninsured services with no regulatory oversight not only violates the College’s mandate to protect the public; it allows Alberta to slip deeper into a two-tiered health system without first engaging the public in a fulsome dialogue about whether this is necessary or desirable.
The move to a two-tiered health system should be made with thoughtful public consultation. It can’t be the unintended consequence of a physician’s desire to control his “financial destiny” or a well-heeled patient’s desire to get to the head of the queue.
*Ms Soapbox offered a comment under her real name, not behind the mask of “Anonymous”.